Work injury management of refractory low back pain: relations with ethnicity, legal representation and diagnosis

While psychosocial factors are known to influence treatment outcomes in low back pain patients, relatively little is known about how they may influenc e work injury management of low back pain. This study examined medical and psychosocial factors associated with work injury management decisions relat ive to patients with occupational low back pain. A retrospective review of 132 patients who had settled their injury claims showed that two psychosoci al factors, ethnicity and litigation status, were associated with work inju ry management. Temporary total disability costs and impairment ratings were lower fur African Americans than for Caucasians, but only in the absence o f legal representation. Similarly, patients with specific pathology underwe nt more treatment, especially diagnostic testing, than patients with non-sp ecific back pain, but only in the presence of legal representation. Having evidence of a specific lesion and legal representation were also associated with claimants' final disability ratings. Results are discussed in terms o f a model of social judgment in which properties of the judge, target, and context influence judgments. Implications for work injury management and di sability determination, as well as future research are discussed. (C) 2001 International Association for the Study of Pain. Published by Elsevier Scie nce B.V. All rights reserved.